切开复位内固定术治疗三踝骨折的临床效果及对踝关节功能的影响

Clinical Effect of Open Reduction and Internal Fixation in the Treatment of Three Ankle Fractures and Its Influence on Ankle Joint Function

目的探讨切开复位内固定术治疗三踝骨折的临床效果及对踝关节功能的影响。方法选取2015年1月—2020年1月收治的70例三踝骨折患者,根据入院顺序分为观察组及对照组,各组35例,对照组行手法复位石膏外固定治疗,观察组实施切开复位内固定术治疗,对两组治疗总有效率、Kofoed评分、下地活动时间、住院时间、骨折愈合时间、后踝复位次数、关节肿胀评分、关节疼痛评分、关节功能评分、X线检查结果评分、并发症发生率进行比较。结果观察组总有效率为94.29%,较对照组77.14%高,差异有统计学意义(χ^(2)=4.200,P<0.05);术前,两组Kofoed评分差异无统计学意义(t=0.094,P>0.05),术后1、3、6个月,观察组Kofoed评分均较对照组高,差异有统计学意义(t=5.378、4.807、3.484,P<0.05);观察组下地活动时间、住院时间、骨折愈合时间均较对照组短,观察组后踝复位次数较对照组少,差异有统计学意义(t=4.713、6.475、7.392、9.409,P<0.05);观察组术后关节肿胀、关节疼痛、关节功能、X线检查结果各项评分明显较对照组高,差异有统计学意义(t=9.957、9.906、10.709、10.208,P<0.05);观察组并发症发生率为5.71%,明显较对照组22.86%低,差异有统计学意义(χ^(2)=4.200,P<0.05);观察组躯体疼痛、精神健康、生理职能、情感职能、总体健康、社会功能各维度生活质量评分均较对照组高,差异有统计学意义(t=19.602、16.488、20.166、22.793、15.495、10.803,P<0.05)。结论切开复位内固定术在三踝骨折中应用价值较高,可提高临床治疗效果,改善患者踝关节功能,缩短下地活动及住院时间,促进骨折快速愈合,还可缓解关节肿胀、疼痛程度,减少并发症发生,提高患者生活质量,值得应用。

Objective To explore the clinical effect of open reduction and internal fixation for the treatment of three ankle fractures and its influence on the ankle joint function.Methods Seventy patients with triple malleolus fractures admitted from January 2015 to January 2020 were selected.According to the order of admission,they were divided into observation group and control group,35 cases in each group.The control group was treated with manual reduction plaster external fixation,and the observation group was treated with open reduction and internal fixation.The total effective rate,Kofoed score,time of ground movement,length of hospital stay,time of fracture healing,times of posterior ankle reduction,joint swelling score,joint pain score,joint function score,X-ray examination result score and incidence of complications were compared between the two groups.Results The total effective rate in the observation group was 94.29%,which was higher than 77.14% in the control group,the difference was statistically significant(χ^(2)=4.200,P<0.05).Before surgery,there was no statistically significant difference in Kofoed score between the two groups(t=0.094,P>0.05).At 1,3,and 6 months after operation,the Kofoed scores of the observation group were higher than those of the control group(t=5.378,4.807,3.484,P<0.05).The observation group's time of ground activity,hospital stay,and fracture healing time were shorter than those of the control group,the number of posterior ankle reductions in the observation group was less than that of the control group,the difference was statistically significant(t=4.713,6.475,7.392,9.409,P<0.05).The scores of postoperative joint swelling,joint pain,joint function,and X-ray examination results of the observation group were significantly higher than those of the control group,the difference was statistically significant(t=9.957,9.906,10.709,10.208,P<0.05).The incidence of complications in the observation group was 5.71%,which was significantly lower than 22.86% in the control group,the difference was statistically significant(χ^(2)=4.200,P<0.05).The scores of quality of life in the dimensions of physical pain,mental health,physiological function,emotional function,general health,and social function in the observation group were higher than those in the control group,the difference was statistically significant(t=19.602,16.488,20.166,22.793,15.495,10.803,P<0.05).Conclusion Open reduction and internal fixation has a high application value in three ankle fractures,which can improve the clinical treatment effect,improve the patient's ankle joint function,shorten the time of ground movement and hospitalization,and promote the rapid healing of the fracture.It can also relieve joint swelling and pain,reduce complications,and improve the quality of life of patients.It is worthy of application.